Update on Juvenile Spondyloarthritis.

Spondyloarthritis (SpA) is a blanket term encompassing entities such as enthesitis-related arthritis, nonradiographic axial SpA, and ankylosing spondylitis. These diseases share many clinical features, including a predilection for inflammation of the entheses and the sacroiliac joints. The nomenclature is based on the evolution of the classification of the disease and the age of the patient. SpA has a prevalence of approximately 1% of the population of the United States, with 10% to 20% of patients experiencing the onset during childhood. Children with onset of arthritis before age 16 years are classified as having juvenile idiopathic arthritis. Children with enthesitis and/or sacroiliitis are further classified as belonging to the enthesitis-related arthritis subtype of juvenile idiopathic arthritis. The initial manifestations can be subtle and will usually include a peripheral pattern of arthritis and enthesitis. It may take several years for axial disease to develop in children. Except for an association with the human leukocyte antigen (HLA-B27) serotype, there are no laboratory markers for the disease, and the radiographic findings are often negative. A careful clinical evaluation for evidence of inflammation in the entheses and the joints and a search for comorbidities are required. Magnetic resonance imaging facilitates the early detection of sacroiliitis, an important feature that may be clinically silent. Because recent studies indicate that earlier introduction of therapy can help achieve better outcomes, rapid identification and treatment of children with SpA is essential.

Chest pain in pediatric patients in the emergency department- Presentation, risk factors and outcomes-A systematic review and meta-analysis.

OBJECTIVE: This study aimed to assess and determine the presentation, risk factors, and outcomes of pediatric patients who were admitted for cardiac-related chest pain. BACKGROUND: Although chest pain is common in children, most cases are due to non-cardiac etiology. The risk of misdiagnosis and the pressure of potentially adverse outcomes can lead to unnecessary diagnostic testing and overall poorer patient experiences. Additionally, this can lead to a depletion of resources that could be better allocated towards patients who are truly suffering from cardiac-related pathology. METHODS: This review was conducted per PRISMA guidelines. This systematic review used several databases including MEDLINE, Embase, Scopus, and Web of Science to obtain its articles for review. RESULTS: A total of 6,520 articles were identified, and 11 articles were included in the study. 2.5% of our study population was found to have cardiac-related chest pain (prevalence = 0.025, 95% CI [0.013, 0.038]). The most commonly reported location of pain was retrosternal chest pain. 97.5% of the study population had a non-cardiac cause of chest pain, with musculoskeletal pain being identified as the most common cause (prevalence = 0.357, 95% CI [0.202, 0.512]), followed by idiopathic (prevalence = 0.352, 95% CI [0.258, 0.446]) and then gastrointestinal causes (prevalence = 0.053, 95% CI [0.039, 0.067]). CONCLUSIONS: The overwhelming majority of pediatric chest pain cases stem from benign origins. This comprehensive analysis found musculoskeletal pain as the predominant culprit behind chest discomfort in children. Scrutinizing our study cohort revealed that retrosternal chest pain stands as the unequivocal epicenter of this affliction. Thorough evaluation of pediatric patients manifesting with chest pain is paramount for the delivery of unparalleled care, especially in the context of potential cardiac risks in the emergency department.

Empowering trainees to promote professionalism.

BACKGROUND: Unprofessional behaviour can interfere with patient care. Empowering trainees to address each other's unprofessional behaviour can help address a larger number of incidents that may not be witnessed by supervisors, as well as promote a culture of professionalism in a teaching programme. The goal of the study was to teach trainees to effectively address observed unprofessional behaviour and to assess the impact of this exercise on the percentage of cases directly addressed, reported or ignored 6-12 months after the initial training. METHODS: Eighty-four trainees participated in objective structured clinical examination (OSCE) cases designed to address a colleague's inappropriate behaviour. Baseline and follow-up surveys performed 6-12 months after the OSCE were completed detailing the number of incidents witnessed in colleagues and the method employed to address those incidents: personally address (with level of satisfaction), report or ignore. RESULTS: There was a significant increase in the number of unprofessional incidents identified after the OSCE (pre-OSCE, 1.12 per resident; post-OSCE, 1.69 per resident; t = 2.27, p = 0.029). Of the 72 incidents at baseline, 43 per cent were addressed directly and 43 per cent of those had a satisfactory resolution. Of the 71 incidents described 6-12 months later, 61 per cent were addressed directly and 79 per cent of those had a satisfactory resolution. Trainees were more likely to address rather than to report unprofessional behaviour χ2 (2, 58) = 13, p = 0.001. Empowering trainees to address each other's unprofessional behaviour can help promote a culture of professionalism DISCUSSION: The intervention had a significant impact on the percentage of trainees that addressed any observed unprofessional behaviour, and the rate of satisfaction after doing so. It did not change the percentage of cases that were neither addressed nor reported.

Pediatric board review course for residents "at risk".

OBJECTIVE: There is a correlation between American Board of Pediatrics In-Training and General Pediatrics Certifying Examination scores. A course targeted mainly for residents "at-risk" based on in-training scores may improve the outcome of the certification exam. The objective of the study was to evaluate the impact of a board review course on pediatric board certification scores, particularly for residents at-risk. METHODS: Residents "at-risk" taking the course (Yes) were compared to residents not taking the course who were not at-risk (No) as well as to a cohort of residents predating the onset of the course with mixed risk (Comparison). Analyses compared board exam scores and passing rates in the three groups and in the subcategory of residents who scored